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mott 104 peds

first year peds

QuestionAnswer
Morbidity GI and Respiratory most common
Hospitalized Child’s Reaction infant Infant Separation anxiety Angry/upset then withdrawn Feel abandoned by paren
Hospitalized Child’s Reaction todler protest loudly, cry to sleep, anger to despair, denial of importance of parent Fear of injury/pain Loss of control ERIKSON: TODDLERS task of autonomy, activity limits and decreased choices leave child to feel powerless Miss rituals/routines May regress
Hospitalized Child’s Reaction preschooler Preschooler Separation anxiety relieves tension through magical thinking, imaginary friends sign of high intelect Fear mutilation Act uncooperatively Ask for parentsMiss rituals May regress
Hospitalized Child’s Reaction school aged School age Separation anxiety Fear disability and death Loss of control may have altered vitals in emotional response Fear pain/bodily harm Miss friends
Hospitalized Child’s Reaction adolesent Adolescent Does not want to appear different Loss of control Miss friends All ages Fear of unknown
Family’s Reaction to childs hospitalization Guilty, helpless, and anxious involve parent in care and encourage them • Blame themselves • Fear of unknown • Financial pressure • Siblings : Angry, resentful, jealous, & guilty involve sibling in care
Safety Supervised • Siderails • Medications • Toys • Equipment • Restraints therapeutic holding: parent holds child for injection
Medical Asepsis • Prevent spread of infection • Disinfect contaminated objects • Use disposable items • Utilize universal precautions
the child in pain Identify words used for pain. Monitor VS eval pain and vitals 15-30 min after admin
Non-pharmacological Pain Management Distraction _ Relaxation _ Heat/ cold
Pharmacological Pain Management NONopioids=mild to moderate opoioids=moderate to severe(consider the effects) oral opioids= oxycodone codine morphine is given IV
pain scale (infants and verry young children)FLACC=face legs activity cry and consolability. FACES(preschool and schoolage)
Height & Weight head circumference •Weigh infant naked • Measure infant supine Above eyebrows/ ears to occipital prominence
vitals special considerations RR,HR are higher, BP lower count (abdominal) rise and fall. in community bp is measured at 3yo. unless renal or heart pt. done on admission. proper size 40%with and 80-100% (bladder length)circumference of arm
vitals special considerations cont. Oral Not after oral surgery Not with seizures Rectal Lubricate Insert 1” Not for newborns Last VS Axillary Hold arm close to body Tympanic Direct toward eardrum Rapid & easy
stages of growth and development NB= birth to 4weeks, infant=one month to one year, toddler 1-3y, 3-6,6-12,12-21
Ht, Wt, & Proportion rapid growth periods: fetal head, infancy trunk, child limbs adolescence genitals
Metabolic Rate higher =more waste producedRENAL, insensible losses FLUID,greater BSA INTEGUMENT
Bone Growth best indicator of biologic age
Critical Periods first 3 months after conception
Integration of Skills Integration of Skills child will focus on one skill while mastering others already learne
hight NB 20inc,liner growth is skeletal.family trait, nutrition and health play a role
weight infant 7lbs, uterine environment plays a role, doubles by 6months, triples by first year
Metabolic Rate Metabolic Rate higher =more waste producedRENAL, insensible losses FLUID,greater BSA INTEGUMENT
Bone Growth best indicator of biologic age, osteoblastic rate high end, calcium stored in ends of long bones
Critical Periods first 3 months after conception
Integration of Skills child will focus on one skill while mastering others already learned
Directional Patterns Cephalocaudal head to toe • Proximodistal inner to outer • General to specific
nutrition MAY be the single most important factor on growth and development
mazlows hierarchy of needs self actualization, esteem, Love(belonging), safty(protection,), activity, physiological needs
Erikson PSYCHOSOCIAL DEVELOPMENT TRUST/MISTRUST ATONOMY/SHAME DOUBT IDENTITY/ROLE DEFUSION INDUSTRY/INFERIORITY INITATIVE/GUILT
TRUST/MISTRUST Infancy:TRUST feeding in a timely and loving manor
ATONOMY/SHAME DOUBT Toddler INDEPENDENCE maintain daily routine allow to dress and feed self
INITATIVE/GUILT Preschooler; CURIOSITY should be encouraged by exploration and questions
INDUSTRY/INFERIORITY School aged: SELF WORTH AND VALUE use activities to express
IDENTITY/ROLE DEFUSION Adolescence DEFINE, INDEPENDENCE promote responsibility and support choices
Kohlberg MORAL DEVELOPMENT PRECONVENTIONAL PRESCHOOL CONVENTIONAL SCHOOL PRINCIPLED MORAL ADOLESCENCE
PRECONVENTIONAL PRESCHOOL(4-7 years old) or premoral, rules are absolute breaking rules result in punishment(4-7 years old)
CONVENTIONAL SCHOOL age (7-11) CONVENTIONAL rules are created for all adhearing to rules is the right thing to do
PRINCIPLED MORAL(12-death) right and wrong based on own perceptions of the world
Piaget COGNITIVE DEVELOPMENT SENSORIMOTOR PREOPERATIONAL PRECONCEPTUAL PERCEPTUAL CONCREAT OPERATION FORMAL OPERATION
SENSORIMOTOR (birth -2years) learns by reflexes, and senses
PREOPERATIONAL(2-7) egocentric every one sees world as he or she does
PRECONCEPTUAL (2-4) general concepts still dumb as hell
PERCEPTUAL (4-7) capable of some reasoning but focus on one aspect of subject at a time(centering)
CONCREAT OPERATION (7-11) reasoning is logical but limited to own experience (cause and effect)
FORMAL OPERATION (11-16) develops abstract concepts. oriented to problem solving
Erickson examples toddlers toddlers ability to do simple daily routines(independence)feed and dress themselfs,
Erikson examples preschoolers cruiosity about enviroment encouraged by exploration and questions, let them play iwth medical equipment if safe. limit with choices. this promotes self satisfaction and broadens their experiences
Erikson examples school age activities provide self worth. school edu, hobbies and interaction with peers can assist with a feeling of accomplishment
Erikson examples Adolescents take responsibility for actions and promote their choices can enhance their identity
Infant Growth Characteristics Rapid growth and development • Individual patterns _ Continuous growth _ Slow and rapid periods • Brain growth most critical
Fontanels close 2mo posterior 2years anterior closes
Reflexes disappear grasp 2mo, primitive 3mo, rooting moro 4mo
Sit up with support 5 mo, pulls self to sit at 6mo,sits alone steady 8 mo
Turn over 4 mo, completely at 6mo
Crawl 7mo
Walk 11-12mo Walk 11-12mo
Tooth develop signs at 5mo, two incisors at 6-10mo
Eating 7mo involvement with feeds, 9mo spoon independent and pincer grasp 4-6mo=cereal, pureed veg fruit one at a time7-8mo,cup juice and finger foods at 9mo,allergenic types after one year old and observe for reactions one new per week.
Talking 9mo rare, 10mo aprox 3 words
Stranger fear 11 mo
Pincer grasp 8 mo- 1year
Infant Needs Love and security • Trust vs Mistrust erikson • Sensory stimulation • Play - solitary • Safety • Nutrition • Dental health
APGAR initial and in 5 min 8-10 good score,4-7 require special care and obs, 0-3 requires resuscitation
icterus neonatorum physiologic jaundice, caused by the destruction of RBCs
kinicterus bilirubin encephalopahty, if jaundice is sever and unchecked can result in brain damage, and death, may also result from cold stress (metabolic jaundice)
infant G/D feeding extrusion reflex(spit out food)disapears around 3-4 mo. cearial 4mo, can handle more complex food 6mo, at 12 mo stomach is 200ml. 2years has mastered spoon.4-6mo solids.cerial4-fruits&veg7-meats8-juice9-alergenic1year
teeth 20 in 2.5, begining at 6mo, no bottels to bed, discurage nite time feedings after one year of age
colic pyroximal abdominal pain usualy goes away by 3months. treatment: prone over a (warm!)hot water bottle*, pacifier, walks car rides, burping, WILL OUTGROW THIS
The Toddler SLOWER GROWTH.control of head hands and feet Curiosity Ritualistic, gross motor quickly develops
Toddler GROSS MOTOR 15mo walks,runs 18-24mo,jumps 30mo. stairs 18-24,throws ball 18m, kicks ball 24m,
Toddler physcial Proportions change arms and legs get longer _ Arms & legs lengthen bone growth important epiphyseal areas _ Muscle growth size and strength of muscle fibers increase • Total of 20 teeth 30mo 2.5---3years
Autonomy vs Shame/Doubt (Erikson) encourage independence, don’t do everything for them, sense of security is gained from independence, but help and limit choice. Independence importance of toileting eating sleeping, tolerates brief independence likes to know where parents are
Anal phase (Freud) _ Toilet training mylination of spine is complete by 2years allowing control of sphincters indication of readiness is waking up dry after substantial nap or sleep 18-24 Mo, sit on potty for 5-10 min MAX, set routine after nap, before meals before bed every day, can sit on toilet reverse style,
Toddler vocalization 15mo, 4-6words,18m 10+ body parts, 24m 300words first name toileting food drink, wont shut up.30m first and last name,pronouns plurals and one color.
Toddler - Common Behavior • Temper tantrums ignore unless hurting self or others and divert to other activity asserting independice • Negativism
Toddler - Fears • Separation anxiety greatest fear separation from parents (never sneek out)mastering separation is a developmental process _ Protest-Despair-Denial • Abandonment • Strangers • Loud noises • Sleep • Large animals
Toddler - Learning Explore & experiment • Imitation • Repetition • Parallel Play • Poor sharing
Toddler - Communication Delayed speech may not indicate mental slowness, direct further questions to pediatrician
Toddler - Communication cont. DDST denver developmental screening test, personal social fine motor adaptive language and gross motor is nither a neuro or intellectual test. Low score merely indicates further eval
Communication _ Keep simple _ Eye level
toddler management help them establish limits for them self and and find socially acceptable outlets for their behavior
DDST Denver developmental test not intellect or neurological. used up to 6years old. does not diagnose anything just indicts need for further testing
the "I message" example I feel angry when u hit your sister, saying your a bad boy demoralizes the child and invokes guilt.
play of the todler not shairing "MINE!" parallel play at first, then as verbage and hand skills pick up, associative play, and may or may not begin cooperative play
The Preschool Child Age 3-6 yr 90% of brain growth achieved.Initiative vs Guilt conflict arises when initiative is punished or criticized
Development of Preschool Child • Egocentrism only sees his or her point of view • Animism objects have life • Artificialism everything is created by human beings sky painted ect • Symbolism pretending that a box is a fort
Development of Preschool Child cont. Preconceptual 2-4 years _ Intuitive thought 4-7years • Magical thinking believes that he can wish things dead. Centering focus is on single aspect ignores everything else
Fears of Preschool Child Bodily harm/ pain poor body boundaries fear insides may spill out band aids are useful with magical thinking, may wonder if sister lost her dong in an accident. • Animals • Dark • Strangers • Ghosts • Night terrors
Fears of Preschool Child more fears than toddlers or older children may be sign of increasing intellect (protective mechanism) Fears fade at 5
Play of Preschool Child • Associative play:playground no rules,in a group • May revert to parallel:play is independent, but near other children Toddlers • Imaginary playmates • Dress up • Imitation Imaginary playmates
the 3 year old delight to parents, helpful, simple household chores.fetching things on command.
the 4 year old is a stormy age bulling, show off, profanity
the five year old responsible, doing what is expected of them, like to finish wwhat they started, games with rules.encourage motor skills tricycles, hammering nails,let em learn not to smash their fingers dont be over bearing and sheltering. as long as it wont kill them
limit TV one to two hours a day
Language delay now is the time to spot delays and be real concerned that your child is experiencing detrimental trouble, ARTICULATION, STUTTERING(repeating ), STAMMERING(pausing), SEEK SPEECH THERAPY
The School Age Child Ages 6 to 12 yrs • Fact over fantasy • Same sex friends • Permanent teeth age 6 molar first perm teeth
Growth of School Age Child Muscle coordination, fine motor skills
Development - School Age Piaget - Concrete thinking from inductive to deductive reasoning, conservation and reversibility,
conservation recognize equal quantities regardless shape
reversibility count backwards and subtract
Industry vs Inferiority child is a worker and a producer wants to accomplish tasks. give praise and have patients, don't hold standards too high
Achievement leads to self esteem, failure has negative effects(learns if he or she is leader or follower)
Development – School Age _ Conscience develops learning right and wrong on the scale of the greater good) • Freud _ Latency _ Identify with same sex parent
Fears of School Age Child Body mutilation fear that body will not return to normal after illness • Changes in body image • Death • Failure
Play of School Age Child Peers (same sex) risk for gang initiation, violence drugs, and sex. • Group activities • Collecting • Ordering • Rule oriented
Language of School Age 3000+ word vocabulary • Complex sentences • Grammar • Express thoughts • Reading • Print _Script
Erikson - Industry vs Inferiority child is a worker and a producer wants to accomplish tasksAchievement leads to self esteem, failure has negative effects(learns if he or she is leader or follower)
Kohlberg Conscience develops learning right and wrong on the scale of the greater good)
Growth of Adolescents Puberty _ Girls 2 years > boys _ Boys growth overall •Weight 50% • Refine fine motor skills • Gross motor adult
Development of Adolescent Piaget - Formal Operations ability to think in abstract or multiview points making inferences • Erikson - Identity vs. Role confusion tries out various rols, begins to think about what role they want
Development of Adolescent Kohlberg Post-conventional consider others viewpoints social responsibility is recognized
Nutrition girls at risk for bulimia nervosa, boys may start body building, protein supplements may be harmful, renal fxn,
Created by: medicalminded